A Competency-Based Approach to Managing Violence with Involuntary Outpatient Treatment

  • Ted Lawlor
  • Albert J. GrudzinskasJr.
  • Jeffrey L. Geller
  • Michael Genovese
Original Paper


Involuntary outpatient treatment is one of the most controversial areas in public psychiatry. There are cogent arguments and strong emotions both for and against the use of it. Yet there is violent behavior towards others by individuals with mental illness who reside in the community that is not managed well even when recognized as highly likely. For individuals already in the community mental health system, the ability to keep them in treatment, even against their will, is necessary in some instances to decrease the likelihood of them engaging in outwardly directed violent behavior.


State agencies Involuntary outpatient treatment Violence Competence 


  1. Brophy v. New England Sinai Hospital, Inc., 497 N.E. 2d 626 (1986), from Mill, On Liberty, In R. Hutchins, (Ed.), 43 Great Books of the Western World, 1952.Google Scholar
  2. Chambers, D. (1972). Alternatives to civil commitment of the mentally ill: Practical guides and constitutional imperatives. Michigan Law Review, 70, 1107–1200.CrossRefGoogle Scholar
  3. Elbogen, E., & Tomkins, A. (2000). From the psychiatric hospital to the community: Integrating conditional release and contingency management. Behavioral Sciences and the Law, 18, 427–444.PubMedCrossRefGoogle Scholar
  4. Geller, J., McDermeit, M., Grudzinskas, A., Lawlor, T. & Fisher, W. (1997). A competency-based approach to court-ordered outpatient commitment. New Directions for Mental Health Services, 75, Fall, 1997.Google Scholar
  5. Hiday, V., & Scheid-Cook, T. (1989). A follow-up of chronic patients committed to outpatient treatment. Hospital and Community Psychiatry, 40, 52–59.PubMedGoogle Scholar
  6. Hiday, V., Swanson, J., Swartz, M., Borum, R., & Wagner, H. (2001). Victimization: A link between mental illness and violence? International Journal of Law and Psychiatry, 24, 559–572.PubMedCrossRefGoogle Scholar
  7. Lawlor, T. (2002). Public sector risk management: A specific model. Administration and Policy in Mental Health, 29, 443–460.PubMedCrossRefGoogle Scholar
  8. Link, B., Stueve, A., & Phelan, J. (1998). Psychotic symptoms and violent behaviors: Probing the components of “threat/control-override” symptoms. Social Psychiatry and Psychiatric Epidemiology, 33, S55–S60.PubMedCrossRefGoogle Scholar
  9. Miller, R. (1992). Need-for-treatment criteria for involuntary civil commitment: Impact in practice. American Journal of Psychiatry, 149, 1380–1384.PubMedGoogle Scholar
  10. Monahan, J., Steadman, H., Silver, E., Appelbaum, P., Robbins, P., Mulvey, E., Roth, L., Grisso, T., & Banks, S. (2001). Rethinking risk assessment: The MacArthur study of mental disorder and violence. New York, NY: Oxford University Press.Google Scholar
  11. NASMHPD website (2005). Mission and Values Statement. Bylaws, preamble, 3/2000.Google Scholar
  12. New York State Office of Mental Health (2005). Assisted outpatient treatment report, Table 9.Google Scholar
  13. Sells, D., Rowe, M., Fisk, D., & Davidson, L. (2003). Violent victimization of persons with co-occurring psychiatric and substance use disorders. Psychiatric Services, 54, 1253–1257.PubMedCrossRefGoogle Scholar
  14. Steadman, H., Mulvey, E., Monahan, J., Robbins, P., Appelbaum, P., Grisso, T., Roth, L., & Silver, E. (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry, 55, 393–401.PubMedCrossRefGoogle Scholar
  15. Swanson, J., Holzer, C., Ganju, V., & Jono, R. (1990). Violence and psychiatric disorder in the community: Evidence from the epidemiologic catchment area studies. Hospital and Community Psychiatry, 41, 761–770.PubMedGoogle Scholar
  16. Swanson, J., Borum, R., Swartz, M., & Hiday, V. (1999). Violent behavior preceding hospitalization among persons with severe mental illness. Law and Human Behavior, 23, 185–204.PubMedCrossRefGoogle Scholar
  17. Swanson, J., Swartz, M., Borum, R., Hiday, V., Wagner, H., & Burns, B. (2000). Involuntary out-patient commitment and reduction of violent behavior in persons with severe mental illness. British Journal of Psychiatry, 176, 324–331.PubMedCrossRefGoogle Scholar
  18. Swartz, M., Swanson, J., Hiday, V., Borum, R., Wagner, H., & Burns, B. (1998). Violence and severe mental illness: The effects of substance abuse and nonadherence to medication. American Journal of Psychiatry, 155, 226–231.PubMedGoogle Scholar
  19. Tarasoff v. Regents of the University of California, 17 Cal 3d 425 (1976).Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Ted Lawlor
    • 1
  • Albert J. GrudzinskasJr.
    • 2
  • Jeffrey L. Geller
    • 3
  • Michael Genovese
    • 4
  1. 1.Department of PsychiatryUniversity of Connecticut Health CenterFarmingtonUSA
  2. 2.Department of PsychiatryUniversity of Massachusetts Medical SchoolMassachusettsUSA
  3. 3.Department of PsychiatryUniversity of Massachusetts Medical SchoolMassachusettsUSA
  4. 4.Winthrop University HospitalMineolaUSA

Personalised recommendations